When you need medical care, your doctors will advise you about the treatment you need and whether you will receive it in an inpatient or outpatient setting. What does that mean for you? In this post, we’ll share the main differences between inpatient and outpatient care to help you prepare.
What is an inpatient?
When you are being treated in hospital, you will need to stay overnight in the hospital while you are being treated.
This could be because you’ve had major surgery and need to be closely monitored to make sure you’re recovering well. You may also need rehabilitation treatment such as physiotherapy to get you back on your feet.
In some cases, good patient care means the hospital needs to make sure you have the right follow-up support to help you with your daily tasks before you can go home.
You may also need hospital treatment as there are different elements involved in your care and it is more efficient for you to stay in hospital so that you can receive coordinated medical care from a range of specialists.
You can also get daily patient care if needed.
What is a day patient?
Day care is something between hospital and outpatient care. It is possible to have surgery as a day case. These are typically lower-risk operations where you need to stay in the hospital for a while, but you’ll usually be able to go home the same day.
Cancer treatment is also sometimes carried out in a day unit, particularly chemotherapy, where you may need to stay in hospital for several hours.
Examples of treatments that are usually performed while you are in the hospital:
- Major surgical procedures include hip or knee replacement surgery or heart surgery.
- Rehabilitation after surgery, such as physiotherapy.
- Care after a major accident.
- Treatment of serious diseases that require constant monitoring, including cancer treatment.
- Hospital treatment of severe burns.
- Mental health support for serious psychiatric conditions or drug and alcohol addiction.
While these treatments require hospital care, you will likely need outpatient care as well. This can be before or after hospital treatment to monitor your progress.
What is an ambulance?
Ambulatory care (sometimes called ambulatory care) is provided when you do not need to stay in the hospital overnight to receive treatment. Instead, you will be able to go to the hospital for an outpatient examination and go home afterwards.
What conditions are suitable for outpatient care?
Outpatient care may be offered for less severe conditions that still require regular treatment over a period of time without hospital admission. These may include musculoskeletal conditions that can be improved with regular physiotherapy.
You may also be treated on an outpatient basis for more serious chronic conditions that need to be monitored, for example, diabetes, asthma, cystic fibrosis or angina.
You may also need outpatient care before hospital treatment to prepare for surgery or to assess the type of treatment you may need.
You will also likely be offered outpatient care after your hospital stay to make sure you are recovering well and so your doctors can plan any further treatment you may need.
Examples of treatments that are usually performed while you are an outpatient:
- Preliminary appointments with a consultant before you receive a diagnosis.
- Diagnostic tests include X-rays, MRIs, PET or CAT scans, and blood tests.
- Routine examinations.
- Physiotherapy.
- Radiotherapy or chemotherapy.
- Consultation.
Does health insurance cover hospital treatment?
Health insurance is intended to cover acute conditions that can be resolved during treatment. All basic health insurance policies cover the hospital care required for this type of condition, so you will be covered if you need to stay overnight in hospital.
What hospital expenses do most health insurance cover?
Health insurance for private hospital care usually covers the following costs:
- Fees to be paid to your medical team, including your consultant, surgeon, anesthetist and nursing staff.
- The cost of the treatment itself, including your medication.
- Accommodation costs during hospital stay.
- All the follow-up care you need while you’re still in the hospital.
Are there differences between hospital covers offered by different insurers?
Depending on your health insurance plan, you may also be able to receive inpatient cancer treatment such as radiotherapy and chemotherapy, as well as surgery. Some insurers will also cover blood and other necessary diagnostic tests just before surgery. Cancer coverage varies depending on your insurance plan, with some insurers including it as standard, while others only offer it as an extra.
Does health insurance cover outpatient care?
Some basic private health insurance policies include access to outpatient services after you have been treated in hospital. Generally speaking, outpatient care is only covered if you choose to add it to your policy and pay an additional premium.
If your health insurance only covers hospital treatment costs, you can go privately for surgery or other hospital treatment. You will then be discharged to the care of your GP, who will see you for examinations and arrange further treatment or rehabilitation through the NHS.
You will need a more comprehensive private health insurance policy if you want to access private outpatient treatment. Alternatively, you can opt for a basic health insurance policy and add outpatient treatment cover as an extra. This will give you access to outpatient treatment without paying the higher premiums of a more comprehensive policy.
When you decide to include outpatient insurance in your policy, it’s worth comparing the level of coverage. There is usually a limit to the amount of outpatient care your insurance plan will pay for. Cover limits are usually £500, £1,000, £1,500 or unlimited.
Why is health insurance more expensive with outpatient treatment?
When insurers set their premiums, they estimate the likelihood that someone will make a claim on the policy. This will involve a number of factors, some of which will relate to you as an individual and others which are more general. These factors mean that outpatient insurance tends to be more expensive to include.
What factors do insurers look at?
The chances of you needing hospital care for a serious illness or major operation are far less than the chances of needing physiotherapy or minor surgery. Most people will need minor diagnostic tests at some point in their lives; serious injuries are much less common.
If you require outpatient care, it may also continue for a longer period of time, meaning the cost to your insurer will be higher and more difficult to predict.
